Abdominal pain differential diagnosis

| Resident
Survival
Guide

|

https://www.wikidoc.org/index.php/Abdominal pain

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]Seyedmahdi Pahlavani, M.D. [3]Iqra Qamar M.D.[4]

## Overview

[edit | edit source]

Diagnosing the cause of abdominal pain can be difficult, because many diseases can cause this symptom. Most frequently the cause is benign and/or self-limiting, but more serious causes may require urgent intervention. Acute abdominal pain is a severe, persistent abdominal pain of sudden onset that is likely to require surgical intervention to treat its cause. The following table summarizes differential diagnosis for abdominal pain.

## Differential Diagnosis of Abdominal Pain

[edit | edit source]

To review the differential diagnosis of Abdominal pain, click here.

To review the differential diagnosis of Abdominal pain and fever, click here.

To review the differential diagnosis of Abdominal pain, nausea and vomiting, click here.

To review the differential diagnosis of Abdominal pain and jaundice, click here.

To review the differential diagnosis of Abdominal pain and weight loss, click here.

To review the differential diagnosis of Abdominal pain and constipation, click here.

To review the differential diagnosis of Abdominal pain and diarrhea, click here.

To review the differential diagnosis of Abdominal pain and GI bleeding, click here.

To review the differential diagnosis of Abdominal pain, fever and jaundice, click here.

To review the differential diagnosis of Abdominal pain, fever, nausea and vomiting, click here.

To review the differential diagnosis of Abdominal pain, fever, and diarrhea, click here.

To review the differential diagnosis of Abdominal pain, fever and constipation, click here.

To review the differential diagnosis of Abdominal pain, fever and weight loss, click here.

To review the differential diagnosis of Abdominal pain, fever and GI bleeding, click here.

To review the differential diagnosis of Abdominal pain, nausea,vomiting and jaundice, click here.

To review the differential diagnosis of Abdominal pain, nausea,vomiting and weight loss, click here.

To review the differential diagnosis of Abdominal pain, nausea,vomiting and constipation, click here.

To review the differential diagnosis of Abdominal pain, nausea,vomiting and diarrhea, click here.

To review the differential diagnosis of Abdominal pain, nausea, vomiting and GI bleeding, click here.

To review the differential diagnosis of Abdominal pain, jaundice and weight loss, click here.

To review the differential diagnosis of Abdominal pain, jaundice and diarrhea, click here.

To review the differential diagnosis of Abdominal pain, jaundice and GI bleeding, click here.

To review the differential diagnosis of Abdominal pain,weight loss and constipation, click here.

To review the differential diagnosis of Abdominal pain,weight loss and diarrhea, click here.

To review the differential diagnosis of Abdominal pain, weight loss and GI bleeding, click here.

To review the differential diagnosis of Abdominal pain, constipation and diarrhea, click here.

To review the differential diagnosis of Abdominal pain, constipation and GI bleeding, click here.

To review the differential diagnosis of Abdominal pain, diarrhea and GI bleeding, click here.

### Abdominal Pain

[edit | edit source]

The following table outlines the major differential diagnoses of abdominal pain.

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram, US = Ultrasound

| Classification of pain in the abdomen based on etiology  | Disease  | Clinical manifestations | Diagnosis  | Comments

|
|
|
|

Symptoms | Signs
Abdominal Pain  | Fever  | Rigors and chills  | Nausea or vomiting  | Jaundice  | Constipation  | Diarrhea  | Weight loss  | GI bleeding  | Hypo-

tension

| Guarding  | Rebound Tenderness  | Bowel sounds  | Lab Findings  | Imaging
Abdominal causes  | Inflammatory causes  | Pancreato-biliary disorders  | Acute suppurative cholangitis  | RUQ | \+  | \+  | \+  | \+  | −  | −  | −  | −  | \+  | \+  | \+  | N  |

* Abnormal LFT
* WBC >10,000

* Ultrasound shows biliary dilatation/stents/tumor

* Septic shock occurs with features of SIRS

Acute cholangitis | RUQ | \+  | −  | −  | \+  | −  | −  | −  | −  | −  | −  | −  | N  |

* Abnormal LFT

* Ultrasound shows biliary dilatation/stents/tumor

* Biliary drainage (ERCP) + IV antibiotics

Acute cholecystitis | RUQ | \+  | −  | \+  | \+  | −  | −  | −  | −  | −  | −  | −  | Hypoactive  |

* Hyperbilirubinemia
* Leukocytosis

| Ultrasound shows:

* Gallstone
* Inflammation

* Murphy’s sign

Acute pancreatitis | Epigastric | \+  | −  | \+  | ±  | −  | −  | \+  | −  | ±  | −  | −  | N  |

* Increased amylase / lipase

* Ultrasound shows evidence of inflammation
* CT scan shows severity of pancreatitis

* Pain radiation to back

Chronic pancreatitis | Epigastric | −  | −  | ±  | ±  | −  | \+  | \+  | −  | −  | −  | −  | N  |

* Increased amylase / lipase
* Increased stool fat content
* Pancreatic function test

| CT scan

* Calcification
* Pseudocyst
* Dilation of main pancreatic duct

* Predisposes to pancreatic cancer

Pancreatic carcinoma | Epigastric | −  | −  | \+  | \+  | −  | \+  | \+  | −  | −  | −  | −  | N  |

* ↑ Alkaline phosphatase
* ↑ serum bilirubin
* ↑ gamma-glutamyl transpeptidase
* ↑ CA 19-9

* MDCT with  PET/CT
* MRI

Skin manifestations may include:

* Bullous pemphigoid
* Cicatricial pemphigoid
* Migratory superficial thrombophlebitis (classic Trousseau's syndrome)
* Pancreatic panniculitis

Disease  | Abdominal Pain  | Fever  | Rigors and chills  | Nausea or vomiting  | Jaundice  | Constipation  | Diarrhea  | Weight loss  | GI bleeding  | Hypo-

tension

| Guarding  | Rebound Tenderness  | Bowel sounds  | Lab Findings  | Imaging  | Comments
Primary biliary cirrhosis | RUQ/Epigastric | −  | −  | −  | \+  | −  | −  | −  | −  | −  | −  | −  | N  |

* Increased AMA level, abnormal LFTs

* ERCP

* Pruritis

Primary sclerosing cholangitis | RUQ | \+  | −  | −  | \+  | −  | −  | −  | −  | −  | −  | −  | N  |

* Increased liver enzymes
* Increased IgM, IgG4
* Anti-neutrophil cytoplasmic antibody (p-ANCA)
* Anti-nuclear antibody (ANA)
* Anti-smooth muscle antibody (Anti-Sm)
* Anti-endothelial antibody
* Anti-cardiolipin antibody

| ERCP and MRCP shows

* Multiple segmental strictures
* Mural irregularities
* Biliary dilatation and diverticula
* Distortion of biliary tree

* The risk of cholangiocarcinoma in patients with primary sclerosing cholangitis is 400 times higher than the risk in the general population.

Cholelithiasis | RUQ/Epigastric | ±  | −  | ±  | ±  | −  | −  | −  | −  | −  | −  | −  | Normal to hyperactive for dislodged stone  |

* Leukocytosis

* Ultrasound shows gallstone

* Fatty food intolerance

Gastric causes  | Peptic ulcer disease | Diffuse  | ±  | −  | \+  | −  | −  | −  | \+  |

* Gastric ulcer- melena and hematemesis
* Duodenal ulcer- melena and hematochezia

| Positive if perforated  | Positive if perforated  | Positive if perforated  | N  |

* Ascitic fluid
* LDH > serum LDH
* Glucose < 50mg/dl
* Total protein > 1g/dl

* Air under diaphragm in upright CXR

* Upper GI endoscopy for diagnosis

Disease  | Abdominal Pain  | Fever  | Rigors and chills  | Nausea or vomiting  | Jaundice  | Constipation  | Diarrhea  | Weight loss  | GI bleeding  | Hypo-

tension

| Guarding  | Rebound Tenderness  | Bowel sounds  | Lab Findings  | Imaging  | Comments
Gastritis | Epigastric | ±  | −  | \+  | −  | −  | −  | Positive in chronic gastritis  | \+  | −  | −  | −  | N  |

* H.pylori infection diagnostic tests

* Endoscopy

* H.pylori gastritis guideline recommendation

Gastroesophageal reflux disease | Epigastric | −  | −  | ±  | −  | −  | −  | −  | −  | −  | −  | −  | N  | N  |

* Gastric emptying studies

* Esophageal manometry
* Endoscopy for alarm signs

Gastric outlet obstruction | Epigastric | −  | −  | ±  | −  | −  | −  | \+  | −  | −  | −  | −  | Hyperactive  |

* Complete blood count
* Basic metabolic panel

* Abdominal x-ray\- air fluid level
* Barium upper GI studies\- narrowed pylorus

* Succussion splash

Gastroparesis | Epigastric | −  | −  | \+  | −  | −  | −  | \+  | −  | ±  | −  | −  | Hyperactive/hypoactive  |

* Hemoglobin
* Fasting plasma glucose
* Serum total protein, albumin, thyrotropin (TSH), and an antinuclear antibody (ANA) titer
* HbA1c

* Scintigraphic gastric emptying

* Succussion splash
* Single photon emission computed tomography (SPECT)
* Full thickness gastric and small intestinal biopsy

Gastrointestinal perforation | Diffuse  | \+  | ±  | \-  | ±  | −  | −  | −  | \+  | \+  | \+  | ±  | Hyperactive/hypoactive  |

* WBC> 10,000

* Air under diaphragm in upright CXR

* Hamman's sign

Dumping syndrome | Lower and then diffuse  | −  | −  | \+  | −  | −  | \+  | \+  | −  | \+  | −  | −  | Hyperactive  |

* Glucose challenge test
* Hydrogen breath test

* Upper GI series
* Gastric emptying study

* Postgastrectomy

Intestinal causes  | Disease  | Abdominal Pain  | Fever  | Rigors and chills  | Nausea or vomiting  | Jaundice  | Constipation  | Diarrhea  | Weight loss  | GI bleeding  | Hypo-

tension

| Guarding  | Rebound Tenderness  | Bowel sounds  | Lab Findings  | Imaging  | Comments
Acute appendicitis | Starts in epigastrium, migrates to RLQ  | \+  | Positive in pyogenic appendicitis  | \+  | −  | −  | ±  | −  | −  | Positive in perforated appendicitis  | \+  | \+  | Hypoactive  |

* Leukocytosis

* Ct scan
* Ultrasound

* Positive Rovsing sign
* Positive Obturator sign
* Positive Iliopsoas sign

Acute diverticulitis | LLQ  | \+  | ±  | \+  | −  | \+  | ±  | −  | \+  | Positive in perforated diverticulitis  | \+  | \+  | Hypoactive  |

* Leukocytosis

* CT scan
* Ultrasound

* History of constipation

Inflammatory bowel disease | Diffuse  | ±  | −  | −  | ±  | −  | \+  | \+  | \+  | −  | −  | −  | Normal or hyperactive  |

* Anti-neutrophil cytoplasmic antibody (P-ANCA) in Ulcerative colitis
* Anti saccharomyces cerevisiae antibodies (ASCA) in Crohn's disease

* String sign on abdominal x-ray in Crohn's disease

Extra intestinal findings:

* Uveitis
* Arthritis

Irritable bowel syndrome | Diffuse  | −  | −  | −  | −  | ±  | ±  | \+  | −  | −  | −  | −  | N  | Normal  | Normal  | Symptomatic treatment

* High dietary fiber

* Osmotic laxatives
* Antispasmodic drugs

Whipple's disease | Diffuse  | ±  | −  | −  | ±  | −  | \+  | \+  | −  | ±  | −  | −  | N  |

* Thrombocytopenia
* Hypoalbuminemia
* Small intestinal biopsy for Tropheryma whipplei

| Endoscopy is used to confirm diagnosis.

Images used to find complications

* Chest and joint x-ray
* CT
* MRI
* Echocardiography

| Extra intestinal findings:

* Uveitis
* Endocarditis
* Encephalitis
* Dementia
* Hepatosplenomegaly
* Arthritis
* Ascites

Disease  | Abdominal Pain  | Fever  | Rigors and chills  | Nausea or vomiting  | Jaundice  | Constipation  | Diarrhea  | Weight loss  | GI bleeding  | Hypo-

tension

| Guarding  | Rebound Tenderness  | Bowel sounds  | Lab Findings  | Imaging  | Comments
Toxic megacolon | Diffuse  | \+  | −  | −  | −  | −  | \+  | −  | −  | \+  | ±  | \+  | Hypoactive  |

* Anemia
* Leukocytosis especially in patients with Clostridium difficile infection
* Hypoalbuminemia
* Metabolic alkalosis associated with a poor prognosis
* Metabolic acidosis secondary to ischemic colitis

| CT and Ultrasound shows:

* Loss of colonic haustration
* Hypoechoic and thickened bowel walls with irregular internal margins in the sigmoid and descending colon
* Prominent dilation of the transverse colon (>6 cm)

* Insignificant dilation of ileal bowel loops (diameter >18 mm) with increased intraluminal gas and fluid

Tropical sprue | Diffuse  | \+  | −  | −  | −  | −  | \+  | \+  | −  | −  | −  | −  | N  |

* Fat soluble vitamin deficiency
* Hypoalbuminemia
* Fecal stool test

| Barium studies:

* Dilation and edema of mucosal folds

* Steatorrhea\- 10-40 g/day (Normal=5 g/day)

Celiac disease | Diffuse  | −  | −  | −  | −  | −  | \+  | \+  | −  | −  | −  | −  | Hyperactive  |

* IgA endomysial antibody
* IgA tissue transglutaminase antibody
* Anti-gliadin antibody
* Small bowel biopsy

| US:

* Bull’s eye or target pattern
* Pseudokidney sign

* Gluten allergy

Infective colitis | Diffuse  | \+  | −  | ±  | −  | −  | \+  | −  | \+  | Positive in fulminant colitis  | ±  | ±  | Hyperactive  |

* Stool culture and studies
* Shiga toxin in bloody diarrhea
* PCR

| CT scan

* Bowel wall thickening
* Edema

Disease  | Abdominal Pain  | Fever  | Rigors and chills  | Nausea or vomiting  | Jaundice  | Constipation  | Diarrhea  | Weight loss  | GI bleeding  | Hypo-

tension

| Guarding  | Rebound Tenderness  | Bowel sounds  | Lab Findings  | Imaging  | Comments
Colon carcinoma | Diffuse/ RLQ/LLQ  | −  | −  | −  | −  | ±  | ±  | \+  | \+  | ±  | −  | −  |

* Normal or hyperactive if obstruction present

* CBC
* Carcinoembryonic antigen (CEA)

* Colonoscopy
* Flexible sigmoidoscopy
* Barium enema
* CT colonography

* PILLCAM 2: A colon capsule for CRC screening may be used in patients with an incomplete colonoscopy who lacks obstruction

Hepatic causes  | Viral hepatitis | RUQ | \+  | −  | \+  | \+  | −  | Positive in Hep A and E  | \+  | −  | Positive in fulminant hepatitis  | Positive in acute  | \+  | N  |

* Abnormal LFTs
* Viral serology

* US

* Hep A and E have fecal-oral route of transmission
* Hep B and C transmits via blood transfusion and sexual contact.

Liver abscess | RUQ  | \+  | \+  | \+  | \+  | −  | ±  | \+  | −  | \+  | \+  | ±  | Normal or hypoactive  |

* CBC
* Blood cultures
* Abnormal liver function tests

* US
* CT

Hepatocellular carcinoma/Metastasis | RUQ  | \+  | −  | −  | \+  | −  | −  | \+  | −  | −  | −  | −  |

* Normal
* Hyperactive if obstruction present

* High levels of AFP in serum
* Abnormal liver function tests

* US
* CT
* Liver biopsy

Other symptoms:

* Splenomegaly
* Variceal bleeding
* Ascites
* Spider nevi
* Asterixis

Disease  | Abdominal Pain  | Fever  | Rigors and chills  | Nausea or vomiting  | Jaundice  | Constipation  | Diarrhea  | Weight loss  | GI bleeding  | Hypo-

tension

| Guarding  | Rebound Tenderness  | Bowel sounds  | Lab Findings  | Imaging  | Comments
Budd-Chiari syndrome | RUQ | ±  | −  | −  | ±  | −  | −  | −  | Positive in liver failure leading to varices  | −  | −  | −  | N  |

* Elevated serum aspartate aminotransferase and alanine aminotransferase levels may be more than five times the upper limit of the normal range.
* Elevated serum alkaline phosphatase and bilirubin levels, decreased serum albumin level.

|  | Findings on CT scan suggestive of Budd-Chiari syndrome include:

* Early enhancement of the caudate lobe and central liver around the inferior vena cava
* Delayed enhancement of the peripheral liver with accompanying central low density (flip-flop appearance)
* Peripheral zones of the liver show reversed portal venous blood flow
* In the chronic phase, there is caudate lobe enlargement and atrophy of the peripheral liver in affected areas

Ascitic fluid examination shows:

* Total protein more than 2.5 g per deciliter
* White blood cells are usually less than 500/μL.

Hemochromatosis | RUQ  | −  | −  | −  | −  | −  | −  | −  | Positive in cirrhotic patients  | −  | −  | −  | N  |

* >60% TS
* >240 μg/L SF
* Raised LFT
Hyperglycemia

* Ultrasound shows evidence of cirrhosis

| Extra intestinal findings:

* Hyperpigmentation
* Diabetes mellitus
* Arthralgia
* Impotence in males
* Cardiomyopathy
* Atherosclerosis
* Hypopituitarism
* Hypothyroidism
* Extrahepatic cancer
* Prone to specific infections

Cirrhosis | RUQ | −  | −  | −  | \+  | −  | −  | \+  | \+  | \+  | −  | −  | N  |

* Hypoalbuminemia
* Prolonged PT
* Abnormal LFTs
* Hyponatremia
* Thrombocytopenia

| US

* Nodular, shrunken liver
* Ascites

* Stigmata of liver disease
* Cruveilhier- Baumgarten murmur

Disease  | Abdominal Pain  | Fever  | Rigors and chills  | Nausea or vomiting  | Jaundice  | Constipation  | Diarrhea  | Weight loss  | GI bleeding  | Hypo-

tension

| Guarding  | Rebound Tenderness  | Bowel sounds  | Lab Findings  | Imaging  | Comments
Peritoneal causes  | Spontaneous bacterial peritonitis | Diffuse  | \+  | −  | −  | Positive in cirrhotic patients  | −  | \+  | −  | −  | ±  | \+  | \+  | Hypoactive  |

* Ascitic fluid PMN>250 cells/mm³
* Culture: Positive for single organism

* Ultrasound for evaluation of liver cirrhosis

Renal causes  | Pyelonephritis  | Unilateral  | \+  | ±  | \+  | −  | −  | −  | −  | −  | \+  | −  | −  | Hypoactive  |

* Urinalysis
* Urine culture
* Blood culture

* CT
* MRI

* CVA tenderness

Renal colic | Flank pain | −  | −  | \+  | −  | −  | −  | −  | −  | −  | −  | −  | N  |

* Hematuria

* Ultrasound
* CT scan

* Colicky abdominal pain
* Dysuria

Hollow Viscous Obstruction  | Small bowel obstruction | Diffuse  | \+  | −  | \+  | −  | \+  | −  | \+  | −  | \+  | \+  | ±  | Hyperactive then absent  |

* Leukocytosis with left shift indicates complications

| Abdominal X ray

* Dilated loops of bowel with air fluid levels
* Gasless abdomen

* "Target sign"– , indicative of intussusception
* Venous cut-off sign" – suggests thrombosis

Volvulus | Diffuse  | \-  | −  | \+  | −  | \+  | −  | −  | −  | Positive in perforated cases  | \+  | \+  | Hyperactive then absent  |

* Leukocytosis

| CT scan and abdominal X ray

* U shaped sigmoid colon

* "Whirl sign"

Biliary colic | RUQ  | −  | −  | \+  | \+  | −  | −  | −  | −  | −  | −  | −  | N  |

* ↑ bilirubin and alkaline phosphatase

* Ultrasound

Disease  | Abdominal Pain  | Fever  | Rigors and chills  | Nausea or vomiting  | Jaundice  | Constipation  | Diarrhea  | Weight loss  | GI bleeding  | Hypo-

tension

| Guarding  | Rebound Tenderness  | Bowel sounds  | Lab Findings  | Imaging  | Comments
Vascular Disorders  | Ischemic causes  | Mesenteric ischemia | Periumbilical  | Positive if bowel becomes gangrenous  | −  | \+  | −  | −  | \+  | \+  | \+  | Positive if bowel becomes gangrenous  | Positive if bowel becomes gangrenous  | −  | Hyperactive to absent  |

* Leukocytosis and lactic acidosis
* Amylase levels
* D-dimer

| CT angiography

* SMA or SMV thrombosis

* Also known as abdominal angina that worsens with eating

Acute ischemic colitis | Diffuse  | \+  | ±  | \+  | −  | −  | \+  | \+  | \+  | \+  | \+  | \+  | Hyperactive then absent  |

* Leukocytosis

| Abdominal x-ray

* Distension and pneumatosis

CT scan

* Double halo appearance, thumbprinting
* Thickening of bowel

* May lead to shock

Hemorrhagic causes  | Ruptured abdominal aortic aneurysm | Diffuse  | ±  | −  | \+  | −  | −  | −  | \+  | \+  | \+  | −  | −  | N  |

* Fibrinogen
* D-dimer

* Focused Assessment with Sonography in Trauma (FAST)

* Unstable hemodynamics

Intra-abdominal or retroperitoneal hemorrhage | Diffuse  | ±  | −  | ±  | −  | −  | −  | −  | \+  | \+  | −  | −  | N  |

* ↓ Hb
* ↓ Hct

* CT scan

* History of trauma

Disease  | Abdominal Pain  | Fever  | Rigors and chills  | Nausea or vomiting  | Jaundice  | Constipation  | Diarrhea  | Weight loss  | GI bleeding  | Hypo-

tension

| Guarding  | Rebound Tenderness  | Bowel sounds  | Lab Findings  | Imaging  | Comments
Gynaecological Causes  | Tubal causes  | Torsion of the cyst/ovary  | RLQ / LLQ  | −  | −  | \+  | −  | −  | −  | −  | −  | −  | ±  | ±  | N  |

* ↑ ESR
* ↑ CRP

* Ultrasound

* Sudden onset & severe pain

Acute salpingitis | RLQ / LLQ  | \+  | ±  | −  | −  | −  | −  | −  | −  | −  | ±  | ±  | N  |

* Leukocytosis

* Pelvic ultrasound

* Vaginal discharge

Cyst rupture  | RLQ / LLQ  | −  | −  | \+  | −  | −  | −  | −  | −  | \+  | ±  | ±  | N  |

* ↑ ESR
* ↑ CRP

* Ultrasound

Pregnancy  | Ruptured ectopic pregnancy | RLQ / LLQ  | −  | −  | \+  | −  | −  | −  | −  | −  | \+  | \+  | \+  | N  |

* Positive pregnancy test

* Ultrasound

| History of

* Missed period
* Vaginal bleeding

Extra-abdominal causes  | Pulmonary disorders  | Pleural empyema | RUQ/Epigastric | \+  | ±  | −  | −  | −  | −  | \+  | −  | −  | −  | −  | N  |

* Thoracentesis

| Chest X-ray

* Pleural opacity

* Localization of effusion

| Physical examination

* Crackles
* Egophony
* Increased tactile fremitus

Pulmonary embolism | RUQ/LUQ  | ±  | −  | −  | −  | −  | −  | −  | −  | ±  | −  | −  | N  |

* ABGs
* D-dimer

* CXR
* V/Q scan
* Spiral CT pulmonary angiogram

* Dyspnea
* Tachycardia
* Pleuretic chest pain

Pneumonia | RUQ/LUQ  | \+  | \+  | \+  | −  | −  | ±  | −  | −  | \+  | −  | −  | Normal or hypoactive  |

* ABGs
* Leukocytosis
* Pancytopenia

* CXR
* CT chest
* Bronchoscopy

* Shortness of breath
* Cough

Cardiovascular disorders  | Myocardial Infarction | Epigastric | ±  | −  | \+  | −  | −  | −  | −  | −  | Positive in cardiogenic shock  | −  | −  | N  |

* Cardiac enzymes

| ECG

Echocardiogram

* Wall motion abnormality
* Wall rupture
* Septal rupture

* Chest pain, tightness, diaphoresis

Complications:

* Arrythmias
* Mitral regurgitation
* Ventricular wall rupture
* Septal rupture

|  |

|
|

|  |
|  |

The following is a list of diseases that present with acute onset severe lower abdominal pain:

Disease | Findings

|

Ectopic pregnancy | History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.[1]
Appendicitis | Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.[2]
Rupturedovarian cyst | Usually spontaneous, can follow history of trauma, mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.[3]
Ovarian cyst torsion | Presents with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.[4]
Hemorrhagic ovarian cyst | Presents with localized abdominal pain, nausea and vomiting. Hypovolemic shock may be present, abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.[4]
Endometriosis | Presents with cyclic pain that is exacerbated by onset of menses, dyspareunia. laparoscopic exploration is diagnostic.[4]
Acute cystitis | Presents with features of increased urinary frequency, urgency, dysuria, and suprapubic pain.[5][6]

## References

[edit | edit source]

1. ↑ Morin L, Cargill YM, Glanc P (2016). "Ultrasound Evaluation of First Trimester Complications of Pregnancy". J Obstet Gynaecol Can. 38 (10): 982–988. doi:10.1016/j.jogc.2016.06.001. PMID 27720100.
2. ↑ Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994). "Acute appendicitis: CT and US correlation in 100 patients". Radiology. 190 (1): 31–5. doi:10.1148/radiology.190.1.8259423. PMID 8259423.
3. ↑ Bottomley C, Bourne T (2009). "Diagnosis and management of ovarian cyst accidents". Best Pract Res Clin Obstet Gynaecol. 23 (5): 711–24. doi:10.1016/j.bpobgyn.2009.02.001. PMID 19299205.
4. ↑ 4.0 4.1 4.2 Bhavsar AK, Gelner EJ, Shorma T (2016). "Common Questions About the Evaluation of Acute Pelvic Pain". Am Fam Physician. 93 (1): 41–8. PMID 26760839.
5. ↑ {{Cite journal | author = W. E. Stamm | title = Etiology and management of the acute urethral syndrome | journal = Sexually transmitted diseases | volume = 8 | issue = 3 | pages = 235–238 | year = 1981 | month = July-September | pmid = 7292216
6. ↑ {{Cite journal | author = W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes | title = Causes of the acute urethral syndrome in women | journal = The New England journal of medicine | volume = 303 | issue = 8 | pages = 409–415 | year = 1980 | month = August | doi = 10.1056/NEJM198008213030801 | pmid = 6993946

Template:Gastroenterology

Template:WikiDoc Sources